ER Health Assist 60 for Adults

INFO

ER Health Assist 60 is a health voucher that covers multiple-use benefits for unlimited medical and dental consultations to PhilCare Makati and MOA Clinics only and single-use benefits up to Php60,000 for outpatient emergency care and hospitalization coverage for viral, bacterial illnesses, and treatment of injuries resulting from accidents (excepts for stroke) in 500+ PhilCare accredited hospitals nationwide.

ER Health Assist 60 is a
health voucher that covers multiple-use benefits for unlimited medical and
dental consultations to PhilCare Makati and MOA Clinics only and single-use
benefits up to Php60,000 for outpatient emergency care and hospitalization
coverage for viral, bacterial illnesses, and treatment of injuries resulting
from accidents (excepts for stroke) in 500+ PhilCare accredited hospitals
nationwide.

It covers the following up
to the benefit limit:

- Room and board (Semi-Private
Room)

- Doctor's fees

- Laboratory and diagnostics
procedures

-Special modalities of
treatment as medically necessary during ER and subject to P5,000 inner limit

-Diagnostics and therapeutic
procedures as medically necessary during ER and confinement

Emergency cases are the sudden, unexpected onset
of illness or injury, which at the time of contract reasonably appeared as
having the potential of causing immediate disability or death or requiring the
immediate alleviation of severe pain and discomfort. Emergency cases include
but are not limited to the following: (a) Massive Bleeding; (b) Acute
Appendicitis; (c) Fractures/multiple injuries secondary to accidents; (d)
Convulsions; (f) illnesses or conditions resulting in moderate or severe
dehydration such as diarrhea or fever; and (h) Syncope. Pre-existing conditions
and those conditions under the general exclusions of PhilCare are not covered.***

Out-Patient Benefit Coverage

One
(1) year unlimited medical consultations (including pre-existing illnesses)
through the following specialists at PhilCare Makati and Moa Clinics only.

oFamily Medicine

oInternal Medicine

oOB Gyne

oOpthalmology

oDermatology

oENT

One
(1) year standard dental coverage at Health Partners dental provider inclusive
of the following:

Pre-existing,
congenital and maternity related conditions are not covered. Also
those cases and conditions declared under the standard general exclusions
are not covered. Pre-existing and congenital conditions – An illness or
condition shall be considered pre-existing if, prior to the effective date
of health coverage the pathogenesis of such illness or condition has
started, whether or not the member is aware of such illness or condition.

Top-Notch Assistance Offline and Online

PhilCare’s
services are delivered through a combination of people and digital channels.
People channels include a team of Liaison Officers in key hospitals assisting
members for admission or confinement, Quick Assist desks in major hospitals, a
24/7 Contact Center manned by nurses and supported by a state of the art
technology platform, and finally, PhilCare-owned clinics and the PhilCare
Clinic@Work worksite clinics supported by a competent medical team.

Our intense
focus on the customer inspired us to pioneer innovation and transform customer
experience through digital channels. Find a provider through PhilCare’s mobile
app,HeyPhil! Check your health program,
transactions, and the latest news about health and wellness through our
interactive portals. Easily repurchase your health plan through our e-Commerce
site and talk to us and your co-PhilCare members through our social media sites. Digital channels
promote convenience and speed of service delivery to our members.

2.For availment of medical procedure, present this voucher together
with a valid identification and the requested lab procedures to PhilCare Makati
and MOA Clinics. Procedures covered are those available only to both clinics.

4.Print and present LOA together with valid identification to chosen
medical specialist/dentist upon availment.

Emergency and
Hospitalization Availment

1.Simply present this voucher
together with a valid identification to the emergency room personnel at the
identified PhilCare-accredited hospital.

2.ER personnel will facilitate
the approval of your availment thru reaching our contact center to verify your
membership eligibility and health coverage. The final medical diagnosis is the
basis for PhilCare’s approval of coverage

3.Once approval has been provided,
request for cancellation of approval to reactivate membership is not allowed.

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Established in 1982, PhilCare is one of the country’s pioneering Health Maintenance Organization (HMO) companies. The company is built on a vision to allow Filipinos enjoy a better quality of life by providing them access to world-class health services.